Readmission Rates of Patients Discharged against Medical Advice: A Matched Cohort Study
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{"title"=>"Readmission rates of patients discharged against medical advice: A matched cohort study", "type"=>"journal", "authors"=>[{"first_name"=>"Mark", "last_name"=>"Choi", "scopus_author_id"=>"7402093989"}, {"first_name"=>"Haerin", "last_name"=>"Kim", "scopus_author_id"=>"57191718692"}, {"first_name"=>"Hong", "last_name"=>"Qian", "scopus_author_id"=>"35364875000"}, {"first_name"=>"Anita", "last_name"=>"Palepu", "scopus_author_id"=>"7003771558"}], "year"=>2011, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"362511860", "sgr"=>"80052548611", "issn"=>"19326203", "pmid"=>"21931723", "scopus"=>"2-s2.0-80052548611", "doi"=>"10.1371/journal.pone.0024459", "isbn"=>"1932-6203"}, "id"=>"cc306127-cafa-3525-aba4-1fbf9c47e4aa", "abstract"=>"OBJECTIVE We compared the readmission rates and the pattern of readmission among patients discharged against medical advice (AMA) to control patients discharged with approval over a one-year follow-up period. METHODS A retrospective matched-cohort study of 656 patients(328 were discharged AMA) who were followed for one year after their initial hospitalization at an urban university-affiliated teaching hospital in Vancouver, Canada that serves a population with high prevalence of addiction and psychiatric disorders. Multivariate conditional logistic regression was used to examine the independent association of discharge AMA on 14-day related diagnosis hospital readmission. We fit a multivariate conditional negative binomial regression model to examine the readmission frequency ratio between the AMA and non-AMA group. PRINCIPAL FINDINGS AMA patients were more likely to be homeless (32.3% vs. 11%) and have co-morbid conditions such as psychiatric illnesses, injection drug use, HIV, hepatitis C and previous gastrointestinal bleeding. Patients discharged AMA were more likely to be readmitted: 25.6% vs. 3.4%, p<0.001 by day 14. The AMA group were more likely to be readmitted within 14 days with a related diagnosis than the non-AMA group (Adjusted Odds Ratio 12.0; 95% Confidence Interval [CI]: 3.7-38.9). Patients who left AMA were more likely to be readmitted multiple times at one year compared to the non-AMA group (adjusted frequency ratio 1.6; 95% CI: 1.3-2.0). There was also higher all-cause in-hospital mortality during the 12-month follow-up in the AMA group compared to non-AMA group (6.7% vs. 2.4%, p = 0.01). CONCLUSIONS Patients discharged AMA were more likely to be homeless and have multiple co-morbid conditions. At one year follow-up, the AMA group had higher readmission rates, were predisposed to multiple readmissions and had a higher in-hospital mortality. Interventions to reduce discharges AMA in high-risk groups need to be developed and tested.", "link"=>"http://www.mendeley.com/research/readmission-rates-patients-discharged-against-medical-advice-matched-cohort-study-1", "reader_count"=>35, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Librarian"=>1, "Student > Doctoral Student"=>4, "Researcher"=>4, "Student > Ph. D. Student"=>5, "Student > Postgraduate"=>3, "Student > Master"=>7, "Other"=>5, "Student > Bachelor"=>3, "Lecturer"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Librarian"=>1, "Student > Doctoral Student"=>4, "Researcher"=>4, "Student > Ph. D. Student"=>5, "Student > Postgraduate"=>3, "Student > Master"=>7, "Other"=>5, "Student > Bachelor"=>3, "Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Nursing and Health Professions"=>3, "Medicine and Dentistry"=>21, "Agricultural and Biological Sciences"=>2, "Arts and Humanities"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>1, "Social Sciences"=>2, "Economics, Econometrics and Finance"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>21}, "Social Sciences"=>{"Social Sciences"=>2}, "Psychology"=>{"Psychology"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Unspecified"=>{"Unspecified"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}}, "reader_count_by_country"=>{"United States"=>1, "Spain"=>1}, "group_count"=>2}

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  • {"files"=>["https://ndownloader.figshare.com/files/737662"], "description"=>"<p>Distribution of readmissions within one year in the by AMA status.</p>", "links"=>[], "tags"=>["readmissions", "ama"], "article_id"=>408022, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Mark Choi", "Haerin Kim", "Hong Qian", "Anita Palepu"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0024459.t004", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Distribution_of_readmissions_within_one_year_in_the_by_AMA_status_/408022", "title"=>"Distribution of readmissions within one year in the by AMA status.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 14:58:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/737695"], "description"=>"<p>NA = not applicable as patients were matched on these variables; N (%) unless otherwise indicated; SD = standard deviation; SRO = single room occupancy; LOS = length of stay; IQR = interquartile range.</p><p>*Number of missing = 6 (3 pairs) and ED visits are exclusive of those resulting in hospital admission.</p>", "links"=>[], "tags"=>["demographics", "ama", "paired", "non-ama"], "article_id"=>408057, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Mark Choi", "Haerin Kim", "Hong Qian", "Anita Palepu"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0024459.t001", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Patient_demographics_and_health_care_use_in_the_AMA_group_and_its_paired_non_AMA_group_/408057", "title"=>"Patient demographics and health care use in the AMA group and its paired non-AMA group.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 14:58:35"}

PMC Usage Stats | Further Information

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  • {"month"=>"6", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"4", "year"=>"2012", "pdf"=>"3", "unique-ip"=>"4", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
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  • {"unique-ip"=>"22", "full-text"=>"21", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"5"}
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  • {"unique-ip"=>"19", "full-text"=>"21", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"3"}
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  • {"unique-ip"=>"10", "full-text"=>"8", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"4"}
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  • {"unique-ip"=>"16", "full-text"=>"18", "pdf"=>"7", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"6"}
  • {"unique-ip"=>"23", "full-text"=>"22", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"7"}
  • {"unique-ip"=>"11", "full-text"=>"10", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"3"}
  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"2"}
  • {"unique-ip"=>"21", "full-text"=>"19", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"8"}
  • {"unique-ip"=>"35", "full-text"=>"37", "pdf"=>"7", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2015", "month"=>"9"}
  • {"unique-ip"=>"23", "full-text"=>"26", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"10"}
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  • {"unique-ip"=>"6", "full-text"=>"6", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"8"}
  • {"unique-ip"=>"12", "full-text"=>"9", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"9"}
  • {"unique-ip"=>"8", "full-text"=>"8", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"10"}
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  • {"unique-ip"=>"12", "full-text"=>"15", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2014", "month"=>"11"}
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  • {"unique-ip"=>"21", "full-text"=>"20", "pdf"=>"12", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"3"}
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Relative Metric

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